- Mental Health»
- Anxiety Disorders
Post-Traumatic Stress Disorder: What It Is and Some Ways to Treat It
Post-traumatic stress disorder (PTSD) was something that I never heard of until I saw an episode of a criminal justice show called Law and Order: Special Victims Unit. In the episode PTSD of the lead detectives in the show named Olivia Benson is suffering from post-traumatic stress disorder because in the season before, in an episode called Undercover she is sexually assault by a male guard. After watching the episode called PTSD sparked my interest and I wanted to know more about the topic.
What Is Post Traumatic Disorder?
Post-traumatic stress disorder is actually a newly discovered disorder. It was first put into the “Diagnostic and Statistical Manual of Mental Health Disorder (DSM) in 1980” (Kim pg.646). Post-traumatic stress disorder as defined by Jane M. Anderson “is an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened” (Anderson pg.1).
Some of the Causes of Post-Traumatic Disorder
Post-traumatic stress disorder can be caused by a traumatic event, these traumatic events may be, but may not necessarily include “violent person assault, natural or human-caused disasters, accidents, or military combat, according to the National Institute of Mental Health” (Anderson pg.1). People with post-traumatic stress disorder also have a lot problems sleeping, feel detachment or numb, or they can be startled easily (Anderson pg.1). Those with post-traumatic stress disorder have three main symptoms that go with this disorder. These symptoms are the most common, but there are more to discover, these symptoms are “re-experiencing of the traumatic event [flash backs or nightmares], chronic avoidance of stimuli associated with trauma, numbing of general responsiveness, and persistent symptoms of increased arousal” (Kim pg.646).
Some Professional Opinions
Some professionals in the field of psychology have opinions of post-traumatic stress disorder as being a stress-induced fear circuitry disorder. This stress-induced fear circuitry disorder “…has been discussed at recent scientific conferences and in related proceedings” (Shin pg.408). This disorder starts with the amygdala, and the amygdala is a part of the brain that controls fear. The amygdala not only controls fear, but it “is also involved in the enhancement of memory for emotional events…” (Shin pg.410).
A Case Study
There has been only one published study that related the continuing emotion of fear and the fear leaving in post-traumatic stress disorder. This study was conducted in 2005 by Bremner and his colleagues. This study “studied 8 women with childhood sexual abuse-related post-traumatic stress disorder and 11 trauma-unexposed women without post-traumatic stress disorder” (Shin pg.410). The women being studied started off with their brains being scanned by a position emission tomography (PET scan) and “during a fear acquisition condition, in which a blue square was paired with and annoying electric shock to the forearm” (Shin pg.410). On another day of the study the women were scanned with the position emission tomography and “in a control condition in which the shock was presented randomly not associated with the blue square” (Shin pg.410). In conclusion of this study the conductors of the study were comparing “the fear acquisition verses control condition, the PTSD group showed a greater left amygdala activation than the control group” (Shin pg.410). Since people with post-traumatic stress disorder symptoms are triggered by things “such as sounds, smells, photographs, and words” (Shin pg.410) it is difficult for people with post-traumatic stress disorder.
Along with some specialists in the field of psychology and therapy saying that post-traumatic stress disorder as being a stress-induced fear circuitry disorder; there are theories that post-traumatic stress disorder by some therapists and psychologists may considered an anxiety disorder. The anxiety goes up in with people with post-traumatic stress disorder. The name of this increase is called elevated anxiety sensitivity and it is related to post-traumatic stress disorder in two ways. One of the ways that elevated anxiety is related to post-traumatic stress disorder is that it “may be a predisposing factor, predating the development of PTSD” (Wald pg.35). Another reason that elevated anxiety is related to post-traumatic stress disorder “is that it both may arise from a traumatic PTSD” (Wald pg.35). This is also another way to treat post-traumatic stress disorder because if a therapist or psychologist can help treat the anxiety this will help the individual with post-traumatic stress over all. Treating the individual with post-traumatic stress disorder because with some with post-traumatic stress disorder, they will associate any sound, smell, photography or anything in the nature with the event that caused their post-traumatic stress disorder and therefore will have anxiety. So, if the therapist or psychologist can eliminate the anxiety that is related to the post-traumatic stress disorder stimuli then a good amount of the post-traumatic disorder is gone. Getting rid of anxiety in an individual with post-traumatic stress disorder will take time and patience.
There are many treatments for post-traumatic stress disorder, more than what I knew before studying this disorder, but “… the majority of individuals who suffer from PTSD do not receive the care that the need” (Knaevelsrud pg.72). I feel that people who suffer with post-traumatic stress disorder may not get the assistance that they need because I feel that the resources are difficult to find. One of the most common forms of treatment of people with post-traumatic stress disorder “… is cognitive behavioral therapy (CBT) combined with drug therapy for more serious cases” (Kim pg.647). Knowing that this is the primary or main type of therapy for people with post-traumatic stress disorder, there must be other types of therapies. In my research of post-traumatic stress disorder and the therapies that go along with it I found new things that I did not know before.
There are three main therapeutic methods that I would like to discuss. The methods or therapies are not all, but only a portion of what therapies are out there for individuals with post-traumatic stress disorder. The first therapy is Internet-Based Treatment. I feel that this treatment is new because the internet has not been around for a long time. There are a few reasons why an individual with post-traumatic stress disorder would choose this method of therapy. One reason is that “online therapeutic services could help to eliminate disparities in health resulting from inequities in people’s access to resources. This applies to people challenged by financial, geographic, physical, or attitudinal barriers to traditional services” (Knaevelsrud pg.72).I feel that another reason why Internet-Based Treatment is good is because it is not as “nerve racking” if they do the treatment online instead of in a treatment center.
One of the first experiments with Internet-Based Treatment was with a randomized controlled trail (RCT) with a German-speaking population. In the study there were 96 people with post-traumatic stress disorder who were selected. These 96 people were in either in ten individual sessions of Internet-Based cognitive behavioral therapy (CBT). This therapy was given over five weeks or a wait-list control group (Knaevelsrud pg.73).
There were some criteria that the individuals had to follow in order to be included in the study:
To be initially included in the study, participants had to (a) have experienced a traumatic event (based on Diagnostic and Statistical Manual of Mental Disorders, fourth edition criteria; American Psychiatric Association, 1994) that occurred at least 1 month before the treatment; (b) be 18 years of age or older, (c) not exceed the cut off scores for dissociation and psychosis, (d) not abuse alcohol or other drugs, (e) not consume neuroleptics, (f) be fluent in written German, and (g) not be receiving treatment elsewhere (Knaevelsrud pg.73).
In the study the participants were given a few writing assignments. These writing assignments were sent through email and the conductors of the experiment responded through email. There were three main topics that this study and these three main topics are exposure, cognitive restricting, and social sharing. I feel that these are three main components to any type of therapy for individuals with post-traumatic stress disorder. The exposure part of the Internet-Based Treatment helps the patient helps to exposure the patient to what he or she is dealing with. The cognitive restricting of this Internet-Base Treatment helps the individual with post-traumatic stress disorder to understand what they are thinking and it can help them think that this post-traumatic stress disorder is not their fault. The social sharing can help the person tell others with post-traumatic stress disorder that they have post-traumatic stress disorder and therefore the individual could help someone else with post-traumatic disorder and vice-versa.
Once the study was complete the participants “were contracted through email 18 months after treatment completion and were invited to complete the 18-month assessment” (Knaevelsrud pg.74). The result of the study is located in the information above, below and in the chart citation follows: Note.Higherscores ontheImpactofEventScaleandBriefSymptomInventoryindicatemoreseveresymptoms. HigherscoresontheShortForm-12indicatehigherlevelsmental/physicalfunctioning (Knaevelsrud pg.75).
In conclusion of the Internet-Based Treatment there is a negative to this type of therapy and it is that “internet-based therapy is a relatively new form of treatment, very little is known about long-term outcomes of Internet-based interventions” (Knaevelsrud pg.73). This I feel is a big factor because I feel that talking with a therapist or a psychologist would be better because the individual can have a face-to-face interaction with someone. Also, you cannot tell if someone is lying through just email. In a face-to face interaction with the client who has post-traumatic stress disorder the therapist or psychologist can read the unconscious facial emotions of their clients to see if they are lying.
Two other treatments that are being used in helping individuals with post-traumatic stress disorder are interoceptive exposure (IE) and trauma-related exposure therapy (TRE). Trauma-related exposure therapy “is among the most effective psychosocial treatments for post-traumatic stress disorder” (Wald pg.34). Trauma-related exposure therapy does not work for all patients and they may still have symptoms of post-traumatic stress disorder.
The definition of interoceptive exposure is “deliberately inducing arousal-related bodily sensations so patient can learn that the sensations have no harmful consequences” (Wald pg.35). Interoceptive exposure helps to reduce anxiety which is common with those with post-traumatic stress disorder. Interoceptive exposure therapy and trauma-related exposure therapy are related by “a person pre-treated with IE should experience less distress during TRE (which is anxiety-provoking) because their anxiety about anxiety has been reduced” (Wald pg.35).
There was a study conducted using the combination of interoceptive exposure therapy and trauma-related exposure therapy. Within this study there were certain criteria that the patient had to follow:
(i) diagnosis of PTSD as primary (most severe) disorder; (ii) over 18 years of age; (iii) fluency in written and spoken English; (iv) able to provide written informed consent; and (iv) able to provide written informed consent; and (v) willingness to suspend any concurrent trauma-related psychosocial treatment and to keep any dose of psychotropic treatment medication constant during the course of the study (Wald pg.35).
In this study there was one person being observed and studied; this woman was called Ms C. Ms C was diagnosed with post-traumatic stress disorder because she witnessed her husband being hit with a car and he was severely physically injured. Ms C’s treatment was “a standardized and detailed treatment protocol was used (available at request). The IE component was developed from the guidelines described by Taylor (2000) and the TRE component used the protocol from Marks et al. (1998)” (Wald pg.36).
The way that Ms C’s therapy was used in interoceptive exposure therapy “considered of 4 sessions because this duration has been found to be effective in substantially reducing anxiety sensitivity in treatment studies of panic disorder” (Wald pg.36). The trauma-related exposure therapy that was used in Ms C’s case “involved 4 90-minutes sessions of imaginal exposure to traumatic events, followed by 4 90-minute session of in vivo exposure to harmless but distressing trauma –related stimuli” (Wald pg.37). Both of these methods helped Ms C with her post-traumatic stress disorder symptoms, although her post-traumatic stress disorder symptoms did not entirely disappear they did reduce. The following chart will show how Ms C’s anxiety and post-traumatic symptoms were week-by-week. Also, the following chart will show how during the IE therapy sessions “show decrease in PTSD symptoms and anxiety sensitivity during IE” (Wald pg.38). The chart will also show during trauma-related exposure therapy that “there was a temporary increase in score during the first imaginal exposure session, followed by a gradual decrease over the remaining TRE sessions” (Wald pg.38). The chart citation follows: Figure.1. ResultsforthePTSDDiagnostic Scale–Symptom Severity(PSDS)andAnxietySensitivityIndex(ASI). S5treatment session (Wald pg.38).
The Case Study Conclusion
In conclusion of the study involving Ms C she is noted to say that “[she] found the treatment to be quiet credible. For example, she reported that the treatment seemed quite logical, giving this question a rating of 8 on a 10-point scale (1=not logical and 10=very logical)” (Wald pg.39). This view of two therapeutic methods which are interoceptive exposure therapy and trauma-related exposure therapy show when treating an individual with post-traumatic stress disorder you can mix therapies together when it best suits the individual. Trying this procedure with other forms of therapies may help to treat post-traumatic stress disorder better and faster.
In conclusion of this glimpse of post-traumatic stress disorder this short paper that displays interesting facts, theories and treatments of post-traumatic stress disorder. Each of the three theories mentioned which are Internet-Based Therapy, interceptive exposure therapy and trauma-related exposure therapy have their positives and negatives. This paper has also shown the reasons and symptoms of post-traumatic stress disorder and some of the treatments that individuals with post-traumatic stress disorder may want to use in their recovery and their healing. Although there are many treatments out there for post-traumatic stress disorder these are just some of the basic treatment options.
Anderson, Jane M. "Post-Traumatic Stress Disorder Recognized In Victims Of Many Traumas. (Cover Story)." Journal Of Controversial Medical Claims 14.2 (2007): 1-11. Academic Search Premier. Web. 8 Dec. 2011.
Knaevelsrud, Christine, and Andreas Maercker. "Long-Term Effects Of An Internet-Based Treatment For Posttraumatic Stress." Cognitive Behaviour Therapy 39.1 (2010): 72-77. Academic Search Premier. Web. 8 Dec. 2011.
Masaru Iwasaki, et al. "Clinical Evaluation Of Paroxetine In Post-Traumatic Stress Disorder (PTSD): 52-Week, Non-Comparative Open-Label Study For Clinical Use Experience." Psychiatry & Clinical Neurosciences 62.6 (2008): 646-652. Academic Search Premier. Web. 8 Dec. 2011.
Shin, Lisa M., and Kathryn Handwerger. "Is Posttraumatic Stress Disorder A Stress-Induced Fear Circuitry Disorder?." Journal Of Traumatic Stress 22.5 (2009): 409-415. Academic Search Premier. Web. 8 Dec. 2011.
Wald, Jaye, and Steven Taylor. "Interoceptive Exposure Therapy Combined With Trauma- Related Exposure Therapy For Post-Traumatic Stress Disorder: A Case Report." Cognitive Behaviour Therapy 34.1 (2005): 34-40. MEDLINE. Web. 8 Dec. 2011.